Abstract
Background Hyponatraemia is a common complication of aneurysmal subarachnoid haemorrhage (SAH). We aimed to determine current neurosurgical practice for the identification, investigation and management of hyponatraemia after SAH. Methods An online questionnaire was completed by UK and Irish neurosurgical trainees and consultant collaborators in the Sodium after Subarachnoid Haemorrhage (SaSH) audit. Results Between August 2019 and June 2020, 43 responses were received from 31 of 32 UK and Ireland adult neurosurgical units (NSUs). All units reported routine measurement of serum sodium either daily or every other day. Most NSUs reported routine investigation of hyponatraemia after SAH with paired serum and urinary osmolalities (94%), urinary sodium (84%), daily fluid balance (84%), but few measured glucose (19%), morning cortisol (13%), or performed a short Synacthen test (3%). Management of hyponatraemia was variable, with units reporting use of oral sodium supplementation (77%), fluid restriction (58%), hypertonic saline (55%), and fludrocortisone (19%). Conclusions Reported assessment of serum sodium after SAH was consistent between units, whereas management of hyponatraemia varied. This may reflect the lack of a specific evidence-base to inform practice.
Highlights
The global impact of the coronavirus (SARS-CoV-2) pandemic has been extensive with over 30 million confirmed cases of COVID-19 and 1 million deaths globally as of October 2020.1 The first case of SARS-CoV-2 in Scotland was identified on March 1, 2020,2 with evidence of sustained community transmission ten days later.[3]
Emergency Paediatric Intensive Care Units (PICUs) admissions for children requiring invasive mechanical ventilation fell as a proportion of cases for the entire population, with an odds ratio of 0.52 for likelihood of admission during lockdown, compared to the equivalent period in previous years
The greatest reduction in PICU admissions was for diseases of the respiratory system; those for injury, poisoning or other external causes were equivalent to previous years
Summary
Introduction The global impact of the coronavirus (SARS-CoV-2) pandemic has been extensive with over 30 million confirmed cases of COVID-19 and 1 million deaths globally as of October 2020.1 The first case of SARS-CoV-2 in Scotland was identified on March 1, 2020,2 with evidence of sustained community transmission ten days later.[3] With a rising number of cases across the United Kingdom (UK), a UK-wide lockdown was implemented on March 23, 2020 (Figure 1A). Public Health Scotland (PHS) and National Records of Scotland (NRS) data shows that by the end of August 2020 in the 0-14 age range there had been 345 confirmed SARS-CoV-2 positive cases, 43 hospital admissions,[6] and no deaths.[7]
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